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Day 1: Observations GARP-SA Inaugural Meeting Hellen Gelband RFF 9 February 2010

Surveillance • NASF • Private hospital data collection • GERMS-SA – TRAC-SOUTH AFRICA (fungal infections)

• STI Surveillance—NICD • National Antimicrobial Resistance Surveillance System – NARSS—NICD • KZN activities • Veterinary surveillance

SURVEILLANCE—THE OPPORTUNITY • CONSOLIDATION, COORDINATION – Definitions – Methods – Indicator organisms – Sampling, etc.

• How does this happen? What is the mechanism and who are the players?

Resistance • Enough to worry about, but the details matter and vary for each drug/bug, and importantly, by urban, peri-urban, rural location. [As elsewhere, highest in urban referral hospitals.] • Calls for tailored guidelines, EDL • Information needs? How does surveillance feed in most usefully?

Ethical dilemma

Who is responsible for antibiotic effectiveness? 窶「 Stewardship窶馬o one has taken responsibility

The Veterinary Side

Veterinary ab use • About 5X the amount of antibiotics used in humans are used in animals • Chickens and pigs are the biggest consumers (as is the case in other countries) • Particular concerns: quinolones, vancomycin • What is the relationship between use in animals and antibiotic resistance in people?

AMR cycle

Aquaculture • No worries! (but pass on the abalone)

Trends in antibiotic sales • For Sanofi-Aventis (top antibiotic seller in SA), increase of 27% from 2008-2009 (includes both price and volume and product mix)

Reducing demand for antibiotics • Topicals? • Point of care diagnostics

Global and local/regional problem (and solutions) 窶「 Global: antibiotic supply, resistance in some cases has cross-border consequences (some clones spread widely), similar solutions in many places 窶「 Local/regional: rapid change in antibiotic resistance profiles in certain cases (even if not understood)窶認rance, Netherlands, Belgium and Kilifi, Kenya

Clonal spread of S. pneumoniae 23F

Facts and conclusions • Resistance is biologically inevitable and its magnitude is proportional to the access of the organism to the antimicrobial. • Increasing access to care will increase resistance. • Developing countries are at great risk given their lack of capacity to detect resistance and to control its ascent. • Unequal access: not enough and too much

GARP and the way forward • Develop the evidence base for policy action on antibiotic resistance • Identify policy opportunities where research dissemination, advocacy, and information can have the greatest impact in slowing the development and spread of resistance.

Dogs, sheep, cheetahs (or silver, antibiotics, bacteria)

Meeting reimbursements Mail to: Belma Ramja Resources for the Future 1616 P Street, NW Washington, DC 20036 USA ORIGINAL RECEIPTS For SA participants, reimbursement will come through Dr. Duse’s office


TIME CHANGE: 7:30 pm [not 6:30]